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Tendinopathy Rehabilitation

Often in Physiotherapy, when it rains it pours, and at the moment it’s raining tendinopathies! Achilles tendon and lateral elbow tendon injuries are among the most common I see. In this blog I’m going to run through some of the more important aspects of tendon rehabilitation.

Identifying the type of tendinopathy

Tendon injuries can occur from a range of reasons, but typically they arise pushing a tendon beyond its load capacity. Usually this is from starting a new form of exercise, increasing intensity of a current exercise or perhaps getting back into exercise after a long break. More specifically though, the two main types of tendon injury are:

  1. Reactive tendons – Usually occur in young individuals who have a sharp increase in activity. Usually there is no previous history and often requires load management as a main source of rehab.
  2. Degenerative tendons – Often occurs in middle age and older adults and are often a more subtle increase in overall load. As people in this category typically are quite sedentary, the best treatment for this is to specifically load the tendon to improve its strength.

How can I strengthen my tendon?

The options for improving tendon tolerance and structures are well researched and many! Your physiotherapist will guide your through your own personalised rehabilitation program, but the basics of tendon exercises are:

  1. Isometric – A contraction holding the joint in a neutral position. This assists with pain reduction and motor control.
  2. Heavy Slow Resistance – More of the classic ‘calf raise’ exercise but with a high load and slow speed. Helps with tendon stiffness and generalised muscle strengthening.
  3. Plyometrics – Include more dynamic jumping-based exercises. This helps return the injured person back to their original activities.
  4. Faster Loads – This is more specific for patients returning to running based injuries. Increase control and strength with speed-based movements is imperative to assist in returning to sport injury free.

How much load is appropriate?

As tendinopathies are an overloading-based injury, know what is ‘too much’ is very important. This is done through monitoring your pain during and after activity. During activity, a pain between 0-5 is acceptable, with 6-10 being and excessive amount of pain. Furthermore, it is important that this pain eases after exercise and does not worsen after. See the diagram below for a simplified version.



A lot of tendon rehabilitations can be very tricky and will need guidance from a health professional. If you have questions about anything within this blog, please get in contact with one of our Physiotherapists here at Bend + Mend Physio.

Ben Cunningham

Ben graduated with a Bachelor of Physiotherapy degree from Australian Catholic University in Brisbane. After a move down to NSW, he has now joined the Bend + Mend Team and works at both Martin Place and Barangaroo clinics. Ben has a particular special interest in treating lower back pain (with referred pain) and running lower limb injuries and always uses the most up to date scientific evidence to assist his patient in reach their full potential. He is intrigued with how the body works and enjoys observing people and their movement patterns to help identify the root cause of complex pain. In his personal time Ben enjoys going to the gym and long distance running. He is also loves heading to the beach and finding new experiences around Sydney!

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